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A1lLn1'S nAML: !oseph Chernach
Au1CS?#: vA81-13133
uA1L Cl uLA1P: 6/7/12
uA1L 1lSSuL 8LCLlvLu: 9/6/12
l8CM: SAC8Lu PLA81 A1PCLCC? uLA81MLn1, LAu CLAl8L WlSCCnSln
1?L Cl SLClMLn: llxLu 88Aln 1lSSuL l8ACMLn1S, blood samples

1he flxed Llssue samples conslsL of LhlrLeen small Llssue fragmenLs, Lhe largesL conslsLs of fronLal corLex, caudaLe, puLamen and globus
pallldus, and superlor Lemporal corLex, hlppocampus, medulla, 2 levels of pons, 2 fragmenLs of cerebellum, upper splnal cord, 2
unldenLlflable corLex and 3 oLher unldenLlflable small fragmenLs

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1. Chronlc 1raumaLlc LncephalopaLhy: SLage ll/lll

CommenL: 1here are abundanL Lau lmmunoreacLlve neuroflbrlllary Langles and neurlLes ln Lhe superlor, dorsolaLeral superlor, lnferlor
fronLal corLlces, Lemporal and parleLal corLlces. 1here ls a sLrong perlvascular procllvlLy as well as accenLuaLlon aL Lhe depLhs of Lhe sulcl.
nl1s are also found ln Lhe Lhalamus, hypoLhalamus, and subsLanLla nlgra and are parLlcularly dense ln Lhe locus coeruleus. 1here ls mld
lnvolvemenL of CA4 of Lhe hlppocampus and enLorhlnal corLex. 1here ls no A, alpha-synucleln or 1u-43 deposlLlon. 1hese flndlngs
lndlcaLe SLage ll/lv C1L and are parLlcularly noLeworLhy glven Lhe young age of Lhe sub[ecL.

3%(** "5./0#.$0(#
(numerlcal score of severlLy key: 0 = none, 1+ = mlld, 2+ = moderaLe, 3+ = severe, 4+ = very severe)

no abnormallLles are noLed

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Avallable for mlcroscoplc examlnaLlon are secLlons from represenLaLlve reglons llsLed below. 1he secLlons have been sLalned wlLh
Luxol fasL blue, hemaLoxylln and eosln (LPL), and wlLh 8lelschowsky sllver.
AddlLlonal sLalnlng meLhods have been used as follows:
A18: 1,2,3,4, 3A, 7, 8,10,11,12, 14,16A, 16, 18, 22, 23, 24, 23
Alpha-synucleln: 1,2,7,11, 21
Amylold beLa: 7,10, 18, 23
1u-43: 2, 3, 7, 11,14, 21, 22, 24
SMl-34: 2, 6, 10, 14, 16A, 24
key sheeL of avallable secLlons
4. lnferlor parleLal corLex (8A 39,40)
3. AnLerlor clngulaLe (8A 24)
3A. Superlor fronLal (8A 8,9)
10. Superlor Lemporal (8A 20, 21,22)
12. Clobus pallldus, lnsula, sub. lnnomlnaLa
14. Plppocampal formaLlon, laLeral genlculaLe
16. 1halamus
20. upper pons (level of locus coruleus)
20A. Lower pons aL vLh cranlal nerve
21. Medulla oblongaLa (lncludlng lnferlor ollves)
22-1. Cervlcal splnal cord
23. Cerebellar vermls
24. Cerebellum wlLh denLaLe nucleus

/0!%(*!(10! '0#,0#3*

l. LepLomenlnges:
llbrosls: 2+ Lhlckenlng

lll. Cerebral 8lood vessels:
ArLerlolosclerosls: none
Amylold anglopaLhy:
LepLomenlnges: none
lnLraparenchymal: none
lv. Cerebral corLex:
CyLoarchlLecLure (radlal and lamlnar): normal
neuronal loss: none
Sponglform change: sllghL vacuolaLlon layer 2
nl1s: (A18)
ClngulaLe: 1+ nl1s
uorsolaLeral fronLal: 4+
lnferlor parleLal: 3+
1emporal lsocorLex : 3+
ulsLrlbuLlon of nl1s:
Cllal nl1s: 2+
WhlLe maLLer nl1 and neurlLes: 1+
erlvascular collecLlons: 4+
aLchy dlsLrlbuLlon depLh of sulcus: 4+
Subplal gllal nl1s: 1+
Superflclal layers nl1s: 1+
A/8lelschowsky
Ss: (dlffuse): none
Ss: (neurlLlc): none
1u-43: none
neuropll doL-llke Lhreads: 4+
MlcrolnfarcLs: none
Lewy bodles: none

Plppocampal formaLlon:
neuronal loss (CA1): none
nl1s[200x: counL CA1: 1+
uenLaLe: none
CA4: 2+
CA2: 1+
Ss: none
Plppocampal sclerosls: none
Plppocampal ferruglnlzaLlon: none
MlcrolnfarcLs: none
1u-43, denLaLe[200x: none
Lewy bodles, CA1, synucleln: none
synucleln poslLlve neurlLes ln CA2/3: none
8allooned neurons, CA1: none

LnLorhlnal corLex:
neuronal loss: none
AsLrocyLosls: none
nl1s layer 4/3 [ 200x: 3+
Ss, layer 4/3[ 100x, neurlLlc: none
lck bodles: none
Lewy bodles: none
8allooned neurons: none

Cerebral whlLe maLLer:
Loss of myellnaLed nerve flbers: 1+
ArLerlolosclerosls: none
MlcrolnfarcLs: none
erlvascular macrophages: 2-3+
Crlbrlform sLaLe: none

v. SubcorLlcal nuclel:

SubsLanLla lnnomlnaLa (nuc basalls MeynerL):
neuronal loss: none
nl1s: 1+

CaudaLe/ uLamen: unremarkable

Clobus pallldus: unremarkable

1halamus: 1-2+ nl1s

PypoLhalamus: 1+ nl1s

vl. 8ralnsLem
SubsLanLla nlgra, pars compacLa:
neuronal loss: none
AsLrocyLosls: 1+
LxLraneuronal plgmenL: 1+
Lewy bodles: none
Lewy neurlLes: none
ale bodles: none
Spherolds: none
nl1s: 2+, neurlLes
1u-43:
MlcrolnfarcLs:
ars reLlculaLa: unremarkable
Cerebral peduncle: unremarkable

uorsal and medlan raphe: unremarkable

Locus coeruleus:
neuronal loss: 1+
nl1s: 4+

8asls ponLls: unremarkable

uorsal nucleus of Lhe vagus: unremarkable
lnferlor ollves: unremarkable
yramld: unremarkable

vll. Cerebellum:
CorLex: + p62 poslLlve neurlLes
uenLaLe nucleus: unremarkable
nl1s: none
urkln[e cells:
neuronal loss: 1+
Spherolds: 1+
WhlLe maLLer:
AsLrocyLosls: 1+
Myelln loss: 1+

vll: Splnal cord:
Cervlcal: unremarkable

ulACnCSLS:

1. Chronlc 1raumaLlc LncephalopaLhy:
2. vascular
3. Au changes
4. L8


nLu8CA1PCLCClS1: ____________________________________________________

Ann C. Mckee, Mu